Internal Medicine Coding Alert

Published on Thu Jul 01, 1999 PDF

Effective January 1, 1999, Medicare beneficiaries were given the right to itemized statements from their healthcare provider for any Medicare item or service
delivered by that provider. Because internists are frequently the primary care providers for many Medicare
patients, they can expect to receive several requests for these statements, say Medicare officials.

In April, a limited number of carriers began printing notices informing beneficiaries of their new right, and inserting these notices into the beneficiaries explanation of benefits (EOBs) or Medicare Summary Notices (MSN). The notice reads: You have a right to request an itemized statement which details each Medicare item or service which you have received from your physician, hospital or any other health supplier or health professional. Please contact them directly if you would like an itemized statement. Beginning July 1, all Medicare carriers will be including this message in their communications with beneficiaries.

Because most physicians have established an itemized billing system for internal accounting purposes, Medicare officials do not feel that providing this service should be an additional burden. Health information personnel in each office will have to configure the software to print an itemized form suitable for giving this information to Medicare beneficiaries that request it.

What are Providers Required to Include?

Xact Medicare Services, the Medicare Part B contractor for the states of Pennsylvania, Delaware and the District of Columbia, is advising its physician practices to include the following information on itemized statements:

Name of beneficiary
Date(s) of services
Description of item or service
Number of services furnished
Provider/supplier charges
An internal reference tracking number
Name and telephone number for beneficiary to obtain more information about the items or services provided.

If the claim has been adjudicated by Medicare, Xact recommends the following information also be included:

Amounts paid by Medicare
Beneficiary responsibility for co-insurance
Medicare claim number.

Providers are expected to help beneficiaries resolve any questions they have about the statement or clarify any discrepancies between the statement and the beneficiarys EOB or MSN. Practices are not permitted to charge beneficiaries for this service, and will face a civil monetary penalty of $100 each time they fail to supply a beneficiary with an itemized statement of services within 30 days of the request.